I am just posting up the article from PCWorld about LinkedIn being hacked.  Apparently a file containing some 6.5 million passwords appeared in a Russian online forum.  They say some 200,000 have already been cracked.  The good news is the file supposedly only contains passwords hashed using the SHA-1 algorithm and does not include user names or any other data.  Some bloggers and news reports state you should change all your account passwords that use the same password as your LinkedIn account.  The article also states that owners of compromised accounts will notice that their LinkedIn account password is no longer valid and they will receive an email from LinkedIn.  I haven’t received one as of yet. Here’s the article from PCWorld:

“Update: LinkedIn Confirms Account Passwords Hacked

By Ian Paul, PCWorld    Jun 6, 2012 8:32 AM

LinkedIn Wednesday confirmed that at least some passwords compromised in a major security breach correspond to LinkedIn accounts.

Vicente Silveira, Director at LinkedIn, confirmed the hack on the company’s blog Wednesday afternoon and outlined steps that LinkedIn is taking to deal with the situation. He wrote that those with compromised passwords will notice that their LinkedIn account password is no longer valid.

Silveira added that owners of compromised accounts will receive an email from LinkedIn with instructions on how to reset their passwords. These owners then will get a second email from LinkedIn customer support that explains the situation at greater length.

Silveira also apologized to those affected, saying LinkedIn takes the security of members very seriously.

The business-focused social network had 161 million users worldwide as of March 31.

Background

LinkedIn Security professionals suspected that the business-focused social network LinkedIn suffered a major breach of its password database. Recently, a file containing 6.5 million unique hashed passwords appeared in an online forum based in Russia. More than 200,000 of these passwords have reportedly been cracked so far.

The file only contains passwords hashed using the SHA-1 algorithm and does not include user names or any other data, security researchers say. However, the breach is so serious that security professionals advise people to change their LinkedIn passwords immediately.

It’s unknown at this point how the file ended up on a public forum or exactly which site the passwords originate from, however; signs indicated this is indeed a breach of LinkedIn. Many of the cracked passwords that have been published to the forum have the common term “LinkedIn” in them, Per Thorsheim a security advisor based in Norway, told PCWorld.

While terms such as Facebook, Twitter and other common online networks are almost nonexistent. Thorsheim was one of the first security researchers to discover the leaked password file.

One common way people create passwords for different websites is to add the name of the site into the passphrase, says Thorsheim. So some people may use the password “1234Facebook” for the world’s largest social network, and then “1234LinkedIn” for LinkedIn and so on. With so many occurrences of the term LinkedIn, Thorsheim says, it seems likely these are in fact LinkedIn passwords.

Thorsheim also said he and at least 12 other sources he trusts within the security community have found hashes of their own LinkedIn passwords in the file.

After hearing Thorsheim’s story and using a copy of the leaked password file, I also found the hash for my own LinkedIn password after running my passphrase through an SHA-1 hash generator. However, doing the same operation for the LinkedIn passwords of two other PCWorld writers yielded no results.

What’s a Hash?

An SHA-1 hash is an algorithm that converts your password into a unique set of numbers and letters. If your password is “LinkedIn1234,” for example, the SHA-1 hex output should always be “abf26a4849e5d97882fcdce5757ae6028281192a.” As you can see that is problematic since if you know the password is hashed with SHA-1, you can quickly uncover some of the more basic passwords that people commonly use.

Often, random bits–known as salting–are added to a hash so that the output is harder to guess. But that does not appear to be the case with these leaked passwords.

What’s also troubling security researchers is that the password database contains entirely unique passwords. It’s unclear whether the people who leaked the password file have more passwords that have not surfaced online. The file may, for example, be an attempt to crowd source the hacking of some of the more difficult passwords. It’s also unknown if the suspected attackers have user names or other data tying these passwords to actual users.

Regarding this issue, LinkedIn’s Silveira wrote: “It is worth noting that the affected members who update their passwords and members whose passwords have not been compromised benefit from the enhanced security we just recently put in place, which includes hashing and salting of our current password databases.”

However, since 6.5 million unsalted hashes have been exposed it does not matter how long or difficult to guess your password is, Thorsheim says. Anyone whose password has been exposed is at risk. You can change your LinkedIn password by following this link and clicking the “change” link next to “Password” just below your profile photo.

This has been a tough week for LinkedIn and security. The Next Web recently reported that an opt-in calendar feature in LinkedIn’s Android and iOS mobile apps was sending user data back to LinkedIn servers as plain text. LinkedIn responded by saying it sends all data back to its servers via an encrypted connection and never saves any user data.

LinkedIn has yet to respond to PCWorld’s request for comment.”

In closing, best to change your passwords since LinkedIn Confirms Account Passwords Hacked.

“If I were given eight hours to chop down a tree, I would use six hours to sharpen my axe.”  - Abraham Lincoln

Beginning Oct. 1, 2013, everyone who is covered by the Health Insurance Portability and Accountability Act (HIPAA) must transition from ICD-9 to ICD-10. Practices need to be preparing now to avoid potential reimbursement issues.

Some major differences between ICD-9 and ICD-10:
• The overall number of codes has significantly changed: There are about 14,000 ICD-9 codes. There are approximately 70,000 ICD-10 codes.
• ICD-10 has alphanumeric categories rather than numeric categories.
• The organization and structure of the codes have been changed.
• Clinical conditions have been regrouped.
• Codes have greater specificity with ICD-10 and are up to seven characters long vs. the five of ICD-9.
• ICD-10 codes may include an “x” placeholder— something not used in ICD-9 codes.

Some benefits of ICD-10:
• More easily conduct research, epidemiological studies and clinical trials.
• More closely monitor resource utilization.
• Improve clinical, financial, and administrative performance.
• Better track public health and risks.
• Reduce the need for attachments to explain a patient’s status.
• Improve payment systems and process claims for reimbursement.
• More effectively set health care policies.

Did you catch that? Health care policy and reimbursement are going to be more influenced by a patient’s overall condition, treatment plans and outcomes than ever before. Providers aren’t accustomed to reimbursement based on diagnosis; however, it seems ICD-10 promises to bring about change to reimbursement methodologies. Not sure exactly what that will look like, but changes are certainly on the way.

Prepare for ICD-10:
• Start now by contacting your vendors (for items such as billing software, electronic health record system and clearinghouse services) to see what progress they have made toward the changes and what plans they have in place to comply with the timeline.
• Appoint someone in the practice to be responsible for keeping up to date with the compliance timeline, training of physicians and staff, and evaluating the overall impact of ICD-10.
- This may be one person for a small practice or a team for a larger practice.
- If no one is available within your staff, invest in a consultant educated in ICD-10 implementation and guidelines.
- Set up a budget for costs pertaining to training and education as well as potential software and hardware upgrades or changes.
• Begin asking payors how they are managing the transition to ICD-10 and whether they anticipate any changes to existing medical policies. There will be obvious changes to “payable” diagnosis codes for medical policies. Because there’s no direct crosswalk from ICD-9 to ICD-10, you’ll need to review all Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs) and each payor’s medical policies pertaining to services routinely rendered by your practice.
• Be prepared to evaluate and make changes to current operations to make ICD-10 transition successful.

Your practice should also be prepared for the implementation of the 5010 protocol for submitting electronic claims. On January 1, 2012, standards for electronic health care transactions change from Version 4010/4010A1 to Version 5010. This is an integral part and an important step to the process of the ICD-10 implementation. The 5010 protocol will allow for the new longer alphanumeric diagnosis codes. Electronic claims submitted to Medicare on or after January 1, 2012, must use the new protocol or they won’t be accepted.

As with any transition, preparation is the key. So the question remains, Is Your Axe Sharp?

—Marty Hudson

HCA, which is the largest hospital operator in the US, is no stranger to buyouts. It struck one in the late 1980s and another in 2006. So far, the strategy has generated huge returns for investors. And on March 10^th HCA hit the public markets again. In all, the company raised $3.79 billion — which makes it the biggest private equity IPO ever.

Opening stock price; $30.  This morning it’s at $33.35.  An 11% return in less than thirty days.  I say that’s pretty good.  Of course, HCA certainly faces some considerable risks. One is the uncertainty regarding health care policy. After all, it seems inevitable that there will be cutbacks because of the huge budget deficits. But they worked a long time on this IPO.  They certainly have weighed the risks.  I put my money (literally) on HCA.

HCA’s IPO is benefiting from the strong momentum created by a series of successful IPOs this year. Over the past few weeks, consumer measurement company Nielsen Holdings raised $1.6 billion, Florida-based BankUnited raised $783 million, and pipeline company Kinder Morgan Inc raised $2.9 billion.  Clearly there is a window here that several companies see as an opportunity.

HCA manages a network of acute care hospitals, clinics and outpatient facilities. There are 164 locations, which have a total of 41,000 beds. In fact, HCA has a footprint in 14 of the top 25 fastest growing markets (with populations over 500,000).  In terms of the financials, HCA generated $30.6 billion in revenues last year and net income of $1.2 billion. When adjusting for certain items, the cash flows were a juicy $5.8 billion.

So HCA took a huge step, how about you; Got Stock?

—Marty Hudson

The world of healthcare is changing at a fast pace.  The 21^st century patient demands quality, compassionate care.  It’s a different world than it was 15 – 20 years ago and healthcare organizations must adopt to stay competitive.

As we work with different healthcare organizations across the country one thing we hear consistently are the questions and comments coming from physician leadership and administration:

“Why can’t we return telephone calls in a timely manner?”

 “I get complaints from patients about our staff being rude.”

“We can’t get our staff to understand the importance of good customer service?”

“Our patients won’t give us email addresses.”

When investigating these problems the reasons from the staff are likewise consistent.  “We’re too busy.”  “We’re understaffed.” “The patient’s are rude.” 

I’m going to be a little tough here.  These are not reasons; these are excuses.  Everyone is busy.  Sometimes there is too few staff.  Patients oftentimes don’t feel good and can be rude.  That is absolutely no reason to be rude back.  They are our customer.  Getting email addresses should be part of your regular demographic request.  Approximately 80% of the U.S. population accesses the internet and has an email address.

I’ll use Southwest Airlines as an example.  My experience at my local airport with Southwest is consistently good.  They are the busiest airline at my airport, yet they are always friendly, courteous and professional.  They oftentimes go out of their way to help. 

Once in Houston, TX, I was traveling with my family when my daughter, with almost no warning, feinted at the security gate.  A ticket agent from Southwest Airlines saw what happened and rushed in to help.  They had no way to know we were actually traveling on Southwest.  They called EMT’s and once they found we were traveling with Southwest encouraged us to spend the night.  They pulled our checked luggage off the plane, which had already been loaded, got us a hotel and transportation to, and back the next morning.  Now that’s customer service and a success story I have told many times. 

Why did we get such service?  Because Southwest Airlines’ vision and mission permeates throughout their organization.  The staff lives and breathes the values of the organization.

This doesn’t just happen.  It’s a top down, bottom up, sideways process.  Want to create this type of value in your organization?  Start with the leadership.  Leadership sets the pace.  Create a culture of excellence by establishing the vision, mission and values of the organization.  Always lead, but give staff the ability to engage in the process.  This creates ownership and an endorsement of the culture.

Communicate the vision, mission and values to the staff and to the patient.  This is not a one-time thing.  It is a consistent communication; it’s a process.  Provide side-to-side communication so that managers and team members can learn from one another.  They are the front-line; make sure they understand the importance of the first impression a patient receives.  Let the patient know you have a high expectation of your service and give them a means to provide feedback. 

Monitor, measure and manage the results to improve where needed, and exploit the things you do well.  This is a closed-loop process that provides consistency and insures positive results. Don’t measure to just look at your score.  Measure so you may manage to improve the results.

If you aren’t doing it, there is no time like now to start.  Ask yourself, ask your physician leadership, ask your staff… Are You Adopting 21^st Century Customer Service?

—Marty Hudson

Below is the introduction to an article from Medscape Business of Medicine. In many malpractice lawsuits the patient claims they were not informed of potential negative outcomes. This goes beyond major procedures. Not obtaining informed consent from patients can oftentimes be a necessary even when it seems like ‘routine’ procedure. Here is the article.

“You told your patient about the risks of a treatment or procedure before it began. Now he’s unhappy about a bad result and is suing you — and he could win! What gives?

It’s important for doctors to know exactly what they need to tell patients before a recommended treatment; and it’s important to do it the right way.

Many doctors are not aware that it’s not only in advance of a major procedure or serious medication regimen that informed consent is required; it’s also required for treatments or procedures that doctors may believe require no “disclosure” or informed consent. As a result, many doctors are not as vigilant with informed consent as they should be.

A lawsuit-in-waiting may start long before the summons and complaint, and even before a patient’s treatment begins. What may happen is that the patient has a result he doesn’t like, and thinks that he would not have had the procedure if he had known about this potential result. If the doctor didn’t tell him about this possible outcome; the patient thinks this result must not be a risk of the procedure, but instead could be caused by the negligence of the doctor.

In a lawsuit for lack of informed consent, the patient usually claims that he was not informed about the risks of the treatment he received and that he would not have agreed to the proposed procedure had he known that this could be the result.

The state laws on informed consent do require the physician to disclose to the patient the risks, benefits, and alternatives of any proposed treatment or procedure. Yet any given treatment or procedure could have hundreds of associated risks. For any medication, all the side effects that are manifested in the US Food and Drug Administration studies could be considered “risks.” If there are 50 potential side effects, you should at least describe the “material risks” whenever you prescribe a drug. Clearly, it is not possible for a physician to discuss every single risk that could possibly occur with every patient.

Physicians could have claims against them for not disclosing the risks of even small things, like mole removal, blood pressure medication, colonoscopy, CT scan, stitches, flu shots, etc.”

Read the entire article. 

Are you or your physicians getting the informed consent they should? Your current process on Informed Consent; Will it Protect You?

—Marty Hudson

Superbowl week.  My team’s not in it, but I still follow it pretty close because I just like football.  Something interesting I ran across is the number of men on both the Packers and the Steelers that weigh over 300 pounds.  There are 26 players on the two teams that weigh north of 300.  That’s amazing!  There are only 53 players on each team.  That’s nearly 25%! There are another 6 players over 300 on their reserve squads.

Some of these guys, I don’t know how they can play football.  B.J. “The Freezer” Raji for the Pack clocks in at 337, according to the roster.  He’s the guy that intercepted Chicago QB Hanie in the NFC Championship and ran for a touchdown.  How does someone that big play football and not drop dead of a heart attack.  With a dance to boot which, by the way, has become so popular, you too can learn how to “Raji”. Green Bay’s first Super Bowl team, 45 years ago, didn’t have a guy heavier than 265 pounds.  Mean Joe Greene, at 275 pounds, was the biggest player on the Steelers when they won their second championship in 1976.

How did these guys get so big, and could any of this really be good for them?  They eat tons of food.  I suppose that’s great when they are young and so very active.  But what are they going to do after football? 

Take the case of Jamie Dukes.  First Reggie White died, followed by Tory Epps and Mel Agee. By mid-2005, former NFL center Jamie Dukes was not only mourning his former teammates, but fearing that morbid obesity would leave his own three children without a father. When Dukes, 44, retired in 1996 his 6-1 frame carried a muscular 290 pounds. A decade later, over-eating and reduced exercise had left him at 385 pounds. The weight-related deaths of his friends and concern of his wife and children led Dukes to undergo gastric banding surgery. In fewer than six months he lost 85 pounds, and is a public face of an issue that has emerged as a silent killer of NFL retirees: obesity.

According to stats provided to The Associated Press by Stats LLC, there was one 300-pound player in the league in 1970, three in 1980, 94 in 1990, 301 in 2000 and 394 at the start of last season.

As guys get bigger, the pressure mounts from teams and the NFL to ‘keep up’.  Speaking of which, Packers nose tackle Howard Green spent the preseason with the Redskins, where they wanted him to play at about 360 pounds. They cut him and he eventually ended up with the Packers. In their media guide, they boasted that he “brings size and bulk to the interior of the defensive front at 6-foot-2, 340 pounds.” “That’s cool for right now,” Green said. “I could do better, but I’ve got to do what I do for right now. You can’t go into depletion mode in the middle of the season. You’ll be weak. You’ll get your butt kicked out here by these guys.”

The man who used to be the poster child for unhealthy NFL living in the Super Bowl city of Dallas is Nate Newton. Once a proud 400-pounder nicknamed “The Kitchen,” he’s now on billboards for gastric-sleeve surgery. The ads scream “Lose Weight Like Nate,” and indeed, Newton is a shell of his former self, weighing in at a svelte 215 pounds. He said all the weight-related health problems he had — diabetic conditions, sleep apnea and more — resolved themselves when he took off the pounds.

On the other end, there’s the story of his fellow Cowboys lineman, Erik Williams, who limped into the Super Bowl media hotel Tuesday on a cane. He recently was diagnosed with severe degenerative arthritis in his hip — a result, in part, of playing in the 300-plus range over 11 seasons. “I’m disabled right now,” he said. “I need two hip replacements. It’s definitely something to look out for.” And yet, he concedes, he wouldn’t change a thing. “If they lose weight, then they jeopardize their position,” Williams said. “Linemen have to be strong, have to be quick, have to be agile. It comes with the territory. They may need hip surgery, it might be toes or it might be knees. I’d just tell guys to just keep doing things you love and whatever consequences come with that, deal with it.”

Is it worth it?  I don’t know.  Depends on your priorities.  When I was 24 years old I probably would not make the same decision as I would today.  Of course, when I was 24 there were no 300 pounders.  One things for sure, 300 Pounds Just Ain’t What It Used To Be!

—Marty Hudson

The U.S. House of Representatives voted to repeal the 2010 Patient Protection and Affordable Care Act as the legislative body’s new Republican majority promised.  Every single Republican voted in favor of the bill, which followed hours of debate.  The final vote tally was 245-189, and the only non-voting member was Democratic Rep. Gabrielle Giffords (D-Ariz.), who remains in serious condition after being shot in Tucson, Ariz. earlier this month.  The three House Democrats who supported the repeal legislation were Dan Boren of Oklahoma, Mike McIntyre of North Carolina and Mike Ross of Arkansas.  The repeal legislation will still need to pass in the Democrat-controlled Senate. Even then its unlikely Obama will sign.

The next day the House voted 253-175 on a resolution that instructs four House committees to work on legislation to replace the Patient Protection and Affordable Care Act, with 14 Democrats supporting the measure.  Included in the resolution was one amendment from Rep. Jim Matheson (D-Utah) to include a permanent fix to the Medicare physician payment formula. The House adopted this amendment, which received support from 428 members, with Rep. John Conyers (D-Mich.) voting against it. Five members—Reps. Jim Costa (D-Calif.), Gabrielle Giffords (D-Ariz.), Donald Payne (D-N.J.), C.A. “Dutch” Ruppersberger (D-Md.) and Don Young (R-Alaska)—did not vote.

Specifically, the resolution directs the House Education and the Workforce, Energy and Commerce, Judiciary and Ways and Means committees to work up legislation that proposes changes to the existing law. It also includes 12 guidelines for the committees, including: providing people with pre-existing medical conditions with access to affordable health coverage; reforming the medical liability system to reduce unnecessary and wasteful healthcare spending; providing states greater flexibility to administer Medicaid programs; prohibiting taxpayer funding of abortions and providing conscience protections for healthcare providers; and expanding incentives to encourage personal responsibility for healthcare coverage and costs.

In another action, three Democratic senators have sent House Speaker Boehner a letter urging the House to quickly pass a measure that would repeal the controversial 1099 reporting requirement in the Patient Protection and Affordable Care Act.  The current provision requires businesses to file a 1099 Form with the Internal Revenue Service for every vendor with whom they have at least $600 in transactions and has been described as burdensome to businesses, especially small businesses.  Sens. Ben Nelson of Nebraska, Maria Cantwell of Washington and Amy Klobuchar of Minnesota wrote in the letter, “Small businesses in our states raised concerns that in order to comply with this new requirement, which takes effect next year, businesses will have to institute new record-keeping methods.  The change is particularly onerous for small businesses, our nation’s engines of growth, who cannot afford to employ extra lawyers and accountants to comply with the new rules.”

I remind you, this is one of the provisions in the 2010 Patient Protection and Affordable Care Act that Speaker Pelosi urged “we have to pass the bill so you can found out what’s in it.”  http://bit.ly/fH5t1l  Wow, now we get to waste taxpayer dollars and our legislative time in trying to correct something that was broken, still broken and…oh who knows…Healthcare Reform; Will They Ever Get it Right?

— Marty Hudson

Interesting article I read this past week on Medscape from WebMD titled “’Some Worms Are Best Left in the Can’ — Should You Hide Medical Errors?”  They posed four questions in Medscape’s ethics survey related to this topic. 

Now I know everyone is different.  Me, I want to know the truth, bottom-line.  Good or bad, don’t hide stuff from me, and never tell me something that is not true.  There is nothing that will make me lose confidence, trust and loyalty faster.  However, there are people that are not that way.  Bad news just causes them to worry, so they would rather not know.  Here are each of the questions with some excerpts.

“Are there times when it’s acceptable to cover up or avoid revealing a mistake if that mistake would not cause harm to the patient?” 60.1% of respondents answered “no,” and the remaining respondents were almost evenly divided between “yes” (19%) and “it depends” (20.9%).  In the “No” camp one quote was “…because it’s difficult to know ahead of time how much a reasonable patient would want to know, erring on the side of disclosure makes the most sense.”  Among the comments on the “yes”‘ side; “If there is a mistake that would have no medical effect but would cause extreme, uncalled-for anxiety, then yes.” “I see no benefit in revealing mistakes of no consequence, like giving a patient Tylenol 650 mg instead of 325 mg.”  “Why shake the patient’s trust in the doctor for something that is irrelevant?”

“Are there times when it is acceptable to cover up or avoid revealing a mistake if that mistake would potentially or likely harm the patient?”  A whopping 94.9% answered in the negative, 1.6% said “yes,” and 3.5% said “it depends.”  The “No” replies included; “Patients have the right to know what went wrong, as well as what went correct in their treatment.”  “Painful and awkward to be sure, but nothing compared to the potential blowback.”  “Once you break the rule of truth, you as a physician might as well quit.”  “Once a mistake is discovered it must be revealed, root cause analysis performed, and patient informed of the mistake, its consequences if any, and plans to prevent a recurrence.”  One hedged their bet, “I would contact an attorney first.”  The “it depends” group included a physician who wrote, “If revealing the mistake won’t change the management and has not yet caused any harm, I think a ‘wait and see’ approach is okay.” Another would hold back “only if revealing the mistake would cause more harm to the patient, i.e., make him stop all needed treatment.”

“Would doctors discuss patient information in situations that did not fully protect patient privacy, ie, socially or in conversation with doctors unrelated to the patient’s care?”  More than three-quarters of respondents — 77% — said “no,” 8.4% said “yes,” and 14.2% found an “it depends” middle ground.  The majority of respondents defended informal conversations about patients with other physicians — which one respondent characterized as “critical to ensuring optimal healthcare” and another called “the best ongoing CME we have — as long as privacy is upheld.” Maintaining anonymity, of course, is easier in big cities than in small towns. Some respondents who insisted that they would never use a name said they did mention age, race, gender, and clinical situation, and as one doctor indicated, “In a smaller community, sometimes details make [identity] apparent.”  Two respondents confessed that they yielded to the temptation to name names when they treated movie stars.  Two doctors who had a different view pointed out, “Physicians tell physicians funny stories about patients every day. Usually names are not important,” and “This kind of connecting with others and defusing workday tensions keeps us alive and functioning and — to some extent — prevents burnout.”  Nice to know you may be the butt of a joke with your own health at stake.

“Is it ever acceptable to break patient confidentiality if you know that a patient’s health condition may be harming others (ie, a patient with HIV or sexually transmitted disease who does not inform their spouse or partner)?”  Only slightly more than half of the respondents, 53.3%, answered “yes” to this question.  Some 20.1% said “no,” and the remaining 26.7% said “it depends.”  “Yes” respondents mentioned the physician’s “duty to warn,” and noted that “One’s freedom of confidentiality only goes as far as someone else’s rights.” Another expressed the view that “Confidentiality is an administrative rule, whereas [avoiding] the likelihood of harm is more of a moral rule and ought to supersede.” A doctor who preferred a deliberative approach answered, “I would discuss the situation with the patient, the hospital ethics committee, and a lawyer. If it is permitted under the law, I would not hesitate to help an innocent partner in danger.”  Among the “it depends”; “Physicians don’t have a duty to people they don’t have a doctor-patient relationship with. Our duty is to the patient, and we are not expected to seek out the patient’s sexual partners. However, knowing that a patient is HIV positive and that he hasn’t informed his significant other of that fact changes the level of duty on the part of the provider.”

Here is the entire article if you would like to take a look; http://bit.ly/hUCqXg

Growing up I was told ‘doing the right thing is never easy, but it’s always right’.  For me the ‘right’ answers to these questions fall into the ‘not easy’ category.  Not everyone agrees.  What do you think; When Is Hiding Medical Errors OK?

— Marty Hudson

Recent reports have come out that state “even though Congress approved a zero percent update for Medicare physician fees in 2011, the CMS calculation for the 2011 conversion factor represents a 7.8554 percent cut.”  Those reports are somewhat misleading if you don’t do your homework and make sure you understand the reason for the adjustment.  The reduction in the conversion factor is necessary due to a rescaling of the RVUs to line up with the Medicare Economic Index. 

In other words RVUs actually increased in certain areas; therefore requiring the decrease in the conversion factor to make the fee schedule neutral.  Here is an example for CPT 99213, established office visit:

                                                            2011      2010     Change

Work RVU                                            0.97       0.97            -0-

Non-fac Practice Exp RVU                   1.05        0.88          (0.17)

Malpractice RVU                                  0.07       0.05           (0.02)

Total                                                    2.09       1.90           (0.19)

Conversion Factor                          33.9764   36.8729    (2.8965)

Fee (w/o Geo Index)                         $71.01   $70.06          $0.95

So, in this example of CPT 99213, the unadjusted fee actually increases from 2010 to 2011 by nearly a dollar.  If you take a look at your most commonly used codes you will discover a lot of ups and downs between the two years, but I have not seen anything significant. 

Of course, you should review your fee schedule every year, compare to CMS and make appropriate changes.  Using the Geographic Index for your area will also make a difference, as they also have changes, both ups and downs.

You can read the CMS Transmission here: http://bit.ly/hWh0Kg

Once you have done your review and analysis, I think you’ll find the changes in the CMS Conversion Factor a Neutral Change (at least for the most part).

— Marty Hudson

Asking patients about specific aspects of their care experience rather than their overall level of satisfaction is a more accurate way to compare the quality of medical practices and individual physicians, according to a study published recently in the BMJ.

More and more we are seeing physician groups and health systems utilizing patient surveys to set physician and staff compensation and setting targets for incentive comp plans.  Why are organizations tying patient surveys to compensation?  It comes down to consumer basics.  In years past patients were not considered ‘consumers’, they were patients.  Bottom line is we are all consumers.  A consumer is anyone who spends money on goods and services.  And what’s the best way to get a consumer to spend their money with you?  Easy; offer goods and services the consumer is happy with.  Consumer is happy, they spend money in your organization, and you have more money to share. 

What’s the best way to find out if a consumer is happy?  Easy; just ask them.  Correct the things they are not happy with and exploit the things they are happy with.  For most of the 20^th century patients (not considered consumers) did what their doctor told them and that was that.  In the 21^st century, patients (now a consumer) do research, ask questions, expect to be informed, and expect good service.  The 21^st century patient will leave a practice if someone is rude to them.  At the very least they will not recommend the practice to friends and family.

What’s the best way to ask your patients?  Easy; use M3-Patient Experience.  A low cost, easy to manage, real-time, on-line survey tool.  If you can buy a book on Amazon.com, you can use M3-Patient Experience.  Learn more at http://www.medicalgps.com/m3pss.html.

Ask your patients about their visit experience.  Pinpoint areas of opportunity and leverage your organization’s strengths.  Experience; Not Satisfaction; Is the Key to Patient Feedback.

— Marty Hudson